الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
Hepatocellular carcinoma is the sixth most common cancer throughout the world. It is the third leading cause of cancer deaths in the world after colorectal and lung cancers. In Egypt, it represents the fourth common cancer. According to the Barcelona Clinic Liver Cancer algorithm, TACE is considered to be the standard treatment for intermediate-stage HCC, which is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function who do not exhibit cancer-related symptoms. DSA was the main imaging method for detecting feeding arteries of HCC including hepatic artery branches and ectopic blood supply. It is quite difficult to identify the feeding arteries of tumor and it may require multiple DSA images from different projections to detect the feeding arteries. Recently, multidetector computed tomography (MDCT) has been applied in a wide variety of vascular diseases of the head, thorax, coronary arteries and abdomen. Multidetector computed tomography angiography (MDCT) including multi-planar reconstruction (MPR), curved planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) is considered a non-invasive technique alternative to DSA for displaying hepatic and perihepatic vessels and determination of the tumor feeding vessels before TACE. The aim of this study was to compare the accuracy of 3D reformatted CT angiography and digital subtraction angiography during transcatheter arterial chemoembolization for identification of feeding arteries of hepatocellular carcinoma. This study was carried on 50 patients diagnosed with HCC who attended to Radiodiagnosis and Imaging Department, Tanta University hospitals & Radio-diagnostic and Intervention Department, Liver institute, Menoufia University and had decision for TACE treatment according to oncology committee during the period from September 2019 to October 2022. All patients were subjected to the following: Clinical assessment including history taking, Laboratory study: it includes all the routine laboratory workup with stress on the level of creatine and blood urea and then the Triphasic CT examination was done. The CT findings were correlated with the data of the DSA of these patients. The study included 39 male patient and 11 female patients. Their age ranged from 44-79 years old with mean of 61.86 years. The majority of patients (76%) had solitary lesion and right lobe was the most affected by focal lesions. The total number of examined focal lesions was 68 lesions; the majority of lesions (82.4%) affected one segment and the most frequent size was from 3-5 cm and presented in (38.2%). The most affected segment was segment VIII presented in 14 lesions (20.6%) and the least affected was segment I presented in only two lesions (2.9%). Among 50 patients; 36 patients (72%) had classic hepatic arterial supply and 14 patients (28%) showed anatomical variation of hepatic artery with Type III variant being the most frequent variant presented in 6 patients (12%). The accuracy of MIP and VR in assessment of hepatic artery anomalies compared to DSA results was 100% and 94% respectively. The total number of feeding arteries was 96 feeders; 93 feeder arteries (96.9%) were from branches of hepatic artery and only 3 feeder arteries (3.1%) were from extra-hepatic source. Most of lesions (70.6%) had single feeder artery, while (20.6%) of lesions had two feeder arteries and only (8.8%) of lesions had more than two feeder arteries. Regarding the accuracy of CT angiography for assessment of feeding arteries of HCC compared to DSA results; MIP has revealed 84 feeder arteries (87.5%) while VR revealed only 23 feeder arteries (24%).